Scenarios for Health Care Reform (Part 1 of 2)

Andy Oram | EMR and HIPAA | May 16, 2017

All reformers in health care know what the field needs to do; I laid out four years ago the consensus about patient-supplied data, widespread analytics, mHealth, and transparency. Our frustration comes in when trying to crack the current hide-bound system open and create change. Recent interventions by US Republicans to repeal the Affordable Care Act, whatever their effects on costs and insurance coverage, offer no promise to affect workflows or treatment. So this article suggests three potential scenarios where reform could succeed, along with a vision of what will happen if none of them take hold.

Andy OramIn the first scenario, a tiny group of selfer-trackers, athletes, and empowered patients start a movement that ultimately wins over hundreds of millions of individuals. These scattered enthusiasts, driven to overcome debilitating health problems or achieve extraordinary athletic feats, start to pursue self-tracking with fanaticism. Consumer or medical-grade devices provide them with ongoing data about their progress, and an open source platform such as HIE of One gives them a personal health record (PHR).

They also take charge of their interactions with the health care system. They find that most primary care providers aren’t interested in the data and concerns they bring, or don’t have time to process those data and concerns in the depth they need, or don’t know how to. Therefore, while preserving standard relationships with primary care providers and specialists where appropriate, the self-trackers seek out doctors and other providers to provide consultation about their personal health programs. A small number of providers recognize an opportunity here and set up practices around these consultations. The interactions look quite different from standard doctor visits....

Open Health News' Take: 

Thoughtful two-part article from Andy Oram on several options to fix the broken care system in the US. The second part can be found here.

Key elements of what he is describing is the need for individuals and their medical caregivers to take control of their medical care as well as their health, fitness and environment. One interesting element of what Andy brings up is that the value and financial rewards for patient data should shift to the patients and their providers, where it belongs.

Addressing the environmental/ecosystem issues, Andy states:

"To further expand the power of the analytics, the government demands exponentially greater transparency not just in medical settings but in all things that make us sick: the food we eat (reversing the rulings that protect manufacturers and restaurants from revealing what they’re putting in our bodies), the air and water that surrounds us...disparities in food and exercise options among neighborhoods, and more. Public awareness leads to improvements in health that lagged for decades."

This is something that has been in our minds a lot lately, as we are seeing an explosion of dangerous insect-borne illnesses such as Lyme disease, carried by ticks (which carry more than a dozen dangerous diseases). Factory farming, as well as the indiscriminate spraying of pesticides and insecticides is playing a major role in the increase in tick populations, as they wipe out their natural predators. Factory farming is also having a major impact in bat colony collapse and bee colony collapse. Bats are the primary way nature controls disease-carrying mosquitoes, and bees are nature's prime polinators. These "ecological" catastrophes are all grave threats to the health and well-being of people. 

To Andy's point, we need to include an examination of the negative impact of factory farming in public health. And health analytics should be leveraged for that purpose.